A forum for critical analysis of international issues and developments of particular relevance to the sustainable political and socio-economic development of Overseas Countries and Territories (OCTs).

01 May 2012

Economic inequality of U.S. dependencies evident as federal health care funding opposed in U.S. Congressional committee

"The impending decrease in funding is indicative of the political and economic deficiencies inherent in the U.S. territorial status where American Samoa, Guam, the Northern Mariana Islands, Puerto Rico and the U.S. Virgin Islands do not have the same political or economic rights as the integrated 50 U.S. states" - a territorial expert.

V.I. Delegate to Congress Donna Christensen's amendment to a U.S. House committee's recommendation regarding the Affordable Care Act was voted down by the committee's Republican majority on Wednesday.

Christensen's amendment sought to restore Medicaid funding to the U.S. territories that would be cut from the federal budget under legislation that would repeal portions of the Health Care and Education Reconciliation Act. The cuts would result in a decrease of 65 percent of Medicaid funding for the territories during the next 10 years, according to a statement Christensen released Wednesday.

Christensen's amendment seeking to counter the Medicaid cuts was voted down 30-21 on a roll call vote along party lines.

"This cut targets the territories, is irresponsible, unprincipled, unjustified and unnecessary, and if implemented would deal the territories a crippling blow," Christensen said in introducing the amendment.

Christensen said the Affordable Care Act addressed, but did not correct traditional discriminatory treatment to the territories regarding Medicaid.

"The federal government pays at least 50 percent of the Medicaid program's cost in each of the states and around 80 percent in the poorest states," she said. "By contrast, federal law imposes an annual cap on funding in the territories. Historically, the territories' caps were shockingly low."

A unified voice from U.S. territorial governors and delegates failed to block Republicans from reducing Medicaid funding for the territories, including the Commonwealth of the Northern Marianas (CNMI).

Delegate Gregorio Kilili Sablan (Ind-MP) said yesterday that Republicans on the U.S. House Energy and Commerce Committee voted to take away some $100 million in Medicaid funding from the CNMI and increase the CNMI's local match by 11 percent.

"As governors serving the over 4.5 million Americans who live in the Territories of the United States, we are writing in strong opposition to the proposed elimination of the funding provided to the Territories under the Patient Protection and Affordable Care Act," Fitial and the other governors said.

But the five territorial governors' plea fell on deaf ears as Republicans voted to de-fund the territories.

The bill repeals a provision of the Affordable Care Act that provided for $6.3 billion in additional funding for Medicaid in the territories from Fiscal Year 2011 through 2019, and increased the territories' Federal Medical Assistance Percentage (FMAP) from 50 percent to 55 percent.

Sablan, in a statement yesterday, said the Republican legislation strips Medicaid funding from all the U.S. territories that they won in health care reform-Obamacare-when Democrats led Congress in 2010.

"With the Commonwealth Health Center in serious jeopardy, with little kids getting turned away from the dentist, there could not be a worse time for Republicans to steal away our Medicaid money. But once again, it is the poor and the weak who take the hit," said Sablan, who has been running as independent but aligns himself with Democrats.

Medicaid is the federal health care program for those with low income.

Some 14,700 people in the Marianas, who cannot afford care, are eligible for hospital care, outpatient services, and prescription drugs through Medicaid.

CNMI officials expressed disappointment with the loss of millions of funding for healthcare.

Sen. Ralph Torres (R-Saipan), chairman of the Senate Committee on Health, said providing healthcare would become more difficult as a result of Medicaid funding cuts.

"Even now, we are experiencing very difficult time to give proper health service," he told Saipan Tribune.

Sablan said territorial delegates worked together to block the legislation.

But he said Republicans killed an amendment offered by Donna Christensen (D-Virgin Islands), who is a member of the Energy and Commerce Committee, on a straight party line vote.

Sablan said 30 Republicans voted to slash Medicaid for the territories by 65 percent over the coming decade.

He said the 21 Committee Democrats voted to protect the territorial Medicaid money and maintain the current 55-45 federal-local match.

"As with last week's vote in the Agriculture Committee to cut food stamps funding our poor families rely on, Republicans in Congress are choosing to balance the budget on the backs of those who can least afford it," Sablan said.

Governors and delegates said Medicaid for the territories has long lagged behind funding for the states, and health in the territories has suffered as a result.

"Instead of working to close the gap between the territories and the rest of the U.S.-as we did in the Democratic-led Congress, the Republican plan is to make the gap wider between those who have adequate medical care and those who have not. How can anyone justify that?" Sablan asked.

The legislation Republicans passed yesterday is part of their effort to repeal Obamacare.

Section 1204 of the health care reform act worked to close the gap in care for the over 4 million Americans in Puerto Rico, the U.S. Virgin Islands, Guam, American Samoa, and the CNMI by providing $6.3 billion in increased Medicaid funding and increasing the federal share of Medicaid from 50 percent to 55 percent.

Sablan said the new funds became available on July 1, 2011 and the CNMI immediately drew down $8.1 million.

That was on top of $6.4 million already received for fiscal 2011. For fiscal year 2012, the CNMI submitted a budget for another $18.2 million in federal medical aid grants, including $17 million for Medicaid, he said.

Over the next eight years, the CNMI will receive $140 million in Medicaid - three times more than before the President signed the health care reform law in 2010.

"That huge increase for the islands passed Congress without a single Republican vote; and now Republicans want to take that money away," Sablan added.

Guam Delegate Madeleine Bordallo also issued a statement yesterday, saying that the Republican attempt to eliminate critical Medicaid funding for the territories shifts the funding problem back to the territories.

"Rather than working with us to remove the cap by decreasing the local match, the Republicans have reduced our funding. This funding has helped to provide critical services for residents in the territories who depend on Medicaid for health coverage, and the loss of these additional funds would negate important progress made toward reducing health disparities among the territories," she said.

Republicans crafted the bill to meet spending targets stipulated in the recently-passed Ryan budget resolution, which requires the Energy and Commerce Committee to reduce the deficit by $96.76 billion over the next decade.

The bill was considered by the full Energy and Commerce Committee yesterday, and is expected to be considered on the House floor in the coming weeks.

Bordallo joined her colleagues from the territories in sending a letter to the Committee chairman to request that he "reconsider" his proposal, which, if enacted, would have many adverse impacts for people residing in the territories.